The candidate is a board-certified rheumatologist interested in applying the methodology of health economics to study fiscal policies that impact the care of patients suffering from arthritis and other rheumatic diseases. He is seeking external funding support so that he might have the protected time to avail himself of formal course studies, research time on the proposed project, and access to his mentors. He has a business background and is currently enrolled in the UCLA School of Public Health, Health Services Ph.D. degree program, with an emphasis on Health Economics. UCLA provides an excellent environment for the development of his career. The Department of Medicine provides formal support for its young investigators through the Scientific Training and Advanced Research program. UCLA has excellent health service researchers and health economists in the Schools of Public Health and Medicine. UCLA has a close working relationship with RAND and the RAND Graduate School. During the award, the candidate will take classes required to complete his Ph.D. degree. A portion of the proposed research will serve as his dissertation. He has enlisted a team of health economists, health service researchers, a rheumatologist and a statistician to teach him the skills he needs to complete the proposed research and to develop his career as an independent researcher with health economic and arthritis expertise. He has proposed to study the impact of the Balanced Budget Act expenditure cuts on post-acute care utilization and clinical outcomes on a 100% sample of Medicare patients who have undergone elective joint replacement surgery or surgical management of hip fracture. He has also proposed to examine managed care cost-shifting to the fee for service sector by studying managed care disenrollment prior to planned surgery (elective joint replacement) and disenrollment prior to unplanned surgery (hip fracture).